Late Day Launch Registration Form

Child's Name (please complete one form for each child from your household that you are registering, Ages Cub Kids/Kindergarten through 8th Grade)

Gender

Male Female

Birthdate (MM/DD/YYYY)

Grade (2019-2020 School Year)

Address

Parents/Guardian

Home Phone

Work Phone

Cell Phone

This address will receive a confirmation email

List names and phone numbers of other adults authorized to drop off/pick-up your child

Emergency Contact & Relationship to Child

Emergency Contact Phone

Special Needs: (learning, behavior, diet, medical, allergies) What can we do to help with these needs?

Yes No

If yes, please share about these special needs:

I would like to register my child for the following Late Day Launch dates (check all that apply, $10/child per event date):

Monday, October 7, 2019 Monday, November 4, 2019 Monday, December 2, 2019

My child plans to eat breakfast (pancakes, sausage, juice, milk) during the morning "breakfast theater" from 7:30-7:50am. (This is included in the cost but must be selected at the time of registration).

Yes, please plan on feeding my child breakfast for each date chosen above. No thank you, my child will eat breakfast at home before coming to the event.

My child has a current liability waiver form on file with ECC ( if signed in June 2019, it is good until 8/31/20). If no or you are unsure, please contact the church office.

Yes No I'm not sure.

I agree to pay $10 for this child to participate in each Late Day Launch date chosen above ($10/child per event date). I understand that the registraton and payment deadline for each event is due one week prior to each late start date. (You may pay for all in advance at once but no registration refunds will be available).

Yes No

Late Day Launch Registration Form

Description

Please Fix the Following